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nasal polyp fix 2 koass haji tht 2016 pptx

Syahnita Laras Hardianti
Syahnita Laras Hardianti

nasal polyp fix 2 koass haji tht 2016 pptx

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Nasal Polyp Consulent dr. Amran Simajuntak, Sp. THT-KL Author: Syahnita Mawarni LH Nuraini Syahputri Aulia Dini R
The Anatomy of human nose The Outside Nose is formed by the hard bones and cartilage which layered by connective tissue and small muscles
The Anatomy of human nose
The Anatomy of human nose
The Anatomy of human nose the medial wall of the septum is formed by hard bone and cartilage Hard bone : -Lamina perpendikularis -Vomer -Krista nasalis os maksila -Krista nasalis os palatina Cartilage: -cartilago septum -kuadrangularis -Kolumela
The Anatomy of human nose The Lateral wall is formed by : Konka Inferior Media Superior
nasal polyp fix 2 koass haji tht 2016 pptx
The Anatomy of human nose Meatus - inferior : there is an estuary of nasolaclimary duct - media : estuary of frontal sinus, maxillary sinus, etmoid anterior sinus - Superior : estuary of etmoid posterior sinus and sfenoid sinus
The Anatomy of human nose The border of nasal cavity : -Inferior : formed by Os Maxilla and Os Palatum -Nasal Palate : formed by lamina kribiformis (part of Os Etmoid) - Posterior : formed by Os Sfenoid
The Anatomy of human nose Nasal Vascularization -Upper part : Etmoid anterior artery and posterior (branch of artery ophtalmica hich is part from interna carotis artery) -The front part : facialis artery -The front septum part : pleksus kiesselbach
The Anatomy of human nose The nasal vein vascularization generally follow the arterial pattern. The vein have no vessel-valve
The Physiology of Human Nose Providing airway for respiration Moistening (humidifying) and warming the entering air Filtering inspired air and cleaning it of foreign matter Serving as a resonating chamber for speech Housing the olfactory reseptor
Nasal Polyps Benign mass that grow inside the nasal cavity Abnormal lesions that emanate from portion of nasal mucosa or paranasal sinuses Most polyp grow from etmoidal sinus mucose usually multiple or sometime billateral.
nasal polyp fix 2 koass haji tht 2016 pptx
Nasal polyps Endoscopic view of left nasal cavity. Polyp protruding from uncinate process
Nasal polyps Left anterior nasal cavity showing an antro-coanal polyp. Sucker is pushing inferior turbinate to one side
Clasification
Pathophysiology Unknown Chronic inflammation Autonomic nervous system dysfunction Genetic predisposition Allergic verses non-allergic
Pathophysiology Associated with allergic conditions 20-50% have asthma Allergic rhinitis 8-26% have aspirin intolerance 50% have alcohol intolerance
Pathophysiology Non allergic conditions Cystic Fibrosis 6-48% have polyps AFS 85% have polyps Young syndrome Churg-Strauss syndrome
Pathophysiology Polyps are more common in patients with non-allergic asthma (13%) than allergic asthma (5%) 3000 atopic patients 0.5% have polyps Norlander et al (1999)
Pathophysiology Various theories Bernstein theory Vasomotor theory Epithelia rupture theory
Pathophysiology Bernstein theory Inflammatory changes in lateral nasal wall or sinus mucosa Polyps originate from contact area Ulceration, reepithelialisation and new gland formation Inflammatory processes from epithelial cells, endothelium and fibroblasts Integrity of sodium channels affected
Frequency Adults 1-4% Children 0.1% All races and social classes M/F 2-4:1 in adults Increasing incidence with age
Clinical Manifestation Asymptomatic Airway obstruction Postnasal drip Dull headaches Snoring Rhinorhoea Hyposmia / Anosmia Epistaxis (often other lesion) Obstructive sleep apnoea Craniofacial abnormalities Optic nerve compression
Differential Encephalocoeles Gliomas Dermoid tumours Haemangiomas Papillomas / transitional cell papillomas Nasopharyngeal angiofibromas Rhabdomyosarcomas Lymphomas Neuroblastomas Sarcomas Chordomas Nasopharyngeal carcinomas
Investigations Sweat test RAST / skin testing Nasal smear Microbiology Eosinophils (allergic component) Neutrophils (chronic sinusitis)
Investigations Coronal CT scan MRI scan Flexible nasendoscopy Rigid nasendoscopy
Treatment Oral and nasal steroids High dose prednisolone and nasal steroid for 20 days will eliminate 50% of polyps Lower bioavailability in modern nasal steroids Poor response in certain groups Intranasal injection not effective Immunotherapy Diet (no effect)
Treatment Traditional polypectomy Microdebrider Endoscopic sinus surgery Recurrence Multiple small polyps common Large and antro-coanal less so
Nasal polypectomy Nasal polyp. Stalk attached to medial maxillary wall
Nasal Polypectomy Microdebrider entering left middle meatus
Summary Common condition in adults Aetiology not fully understood Majority are not allergic in nature Medical treatment can be effective Even with surgery, recurrence is common
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nasal polyp fix 2 koass haji tht 2016 pptx

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nasal polyp fix 2 koass haji tht 2016 pptx

  • 1. Nasal Polyp Consulent dr. Amran Simajuntak, Sp. THT-KL Author: Syahnita Mawarni LH Nuraini Syahputri Aulia Dini R
  • 2. The Anatomy of human nose The Outside Nose is formed by the hard bones and cartilage which layered by connective tissue and small muscles
  • 5. The Anatomy of human nose the medial wall of the septum is formed by hard bone and cartilage Hard bone : -Lamina perpendikularis -Vomer -Krista nasalis os maksila -Krista nasalis os palatina Cartilage: -cartilago septum -kuadrangularis -Kolumela
  • 6. The Anatomy of human nose The Lateral wall is formed by : Konka Inferior Media Superior
  • 8. The Anatomy of human nose Meatus - inferior : there is an estuary of nasolaclimary duct - media : estuary of frontal sinus, maxillary sinus, etmoid anterior sinus - Superior : estuary of etmoid posterior sinus and sfenoid sinus
  • 9. The Anatomy of human nose The border of nasal cavity : -Inferior : formed by Os Maxilla and Os Palatum -Nasal Palate : formed by lamina kribiformis (part of Os Etmoid) - Posterior : formed by Os Sfenoid
  • 10. The Anatomy of human nose Nasal Vascularization -Upper part : Etmoid anterior artery and posterior (branch of artery ophtalmica hich is part from interna carotis artery) -The front part : facialis artery -The front septum part : pleksus kiesselbach
  • 11. The Anatomy of human nose The nasal vein vascularization generally follow the arterial pattern. The vein have no vessel-valve
  • 12. The Physiology of Human Nose Providing airway for respiration Moistening (humidifying) and warming the entering air Filtering inspired air and cleaning it of foreign matter Serving as a resonating chamber for speech Housing the olfactory reseptor
  • 13. Nasal Polyps Benign mass that grow inside the nasal cavity Abnormal lesions that emanate from portion of nasal mucosa or paranasal sinuses Most polyp grow from etmoidal sinus mucose usually multiple or sometime billateral.
  • 15. Nasal polyps Endoscopic view of left nasal cavity. Polyp protruding from uncinate process
  • 16. Nasal polyps Left anterior nasal cavity showing an antro-coanal polyp. Sucker is pushing inferior turbinate to one side
  • 18. Pathophysiology Unknown Chronic inflammation Autonomic nervous system dysfunction Genetic predisposition Allergic verses non-allergic
  • 19. Pathophysiology Associated with allergic conditions 20-50% have asthma Allergic rhinitis 8-26% have aspirin intolerance 50% have alcohol intolerance
  • 20. Pathophysiology Non allergic conditions Cystic Fibrosis 6-48% have polyps AFS 85% have polyps Young syndrome Churg-Strauss syndrome
  • 21. Pathophysiology Polyps are more common in patients with non-allergic asthma (13%) than allergic asthma (5%) 3000 atopic patients 0.5% have polyps Norlander et al (1999)
  • 22. Pathophysiology Various theories Bernstein theory Vasomotor theory Epithelia rupture theory
  • 23. Pathophysiology Bernstein theory Inflammatory changes in lateral nasal wall or sinus mucosa Polyps originate from contact area Ulceration, reepithelialisation and new gland formation Inflammatory processes from epithelial cells, endothelium and fibroblasts Integrity of sodium channels affected
  • 24. Frequency Adults 1-4% Children 0.1% All races and social classes M/F 2-4:1 in adults Increasing incidence with age
  • 25. Clinical Manifestation Asymptomatic Airway obstruction Postnasal drip Dull headaches Snoring Rhinorhoea Hyposmia / Anosmia Epistaxis (often other lesion) Obstructive sleep apnoea Craniofacial abnormalities Optic nerve compression
  • 26. Differential Encephalocoeles Gliomas Dermoid tumours Haemangiomas Papillomas / transitional cell papillomas Nasopharyngeal angiofibromas Rhabdomyosarcomas Lymphomas Neuroblastomas Sarcomas Chordomas Nasopharyngeal carcinomas
  • 27. Investigations Sweat test RAST / skin testing Nasal smear Microbiology Eosinophils (allergic component) Neutrophils (chronic sinusitis)
  • 28. Investigations Coronal CT scan MRI scan Flexible nasendoscopy Rigid nasendoscopy
  • 29. Treatment Oral and nasal steroids High dose prednisolone and nasal steroid for 20 days will eliminate 50% of polyps Lower bioavailability in modern nasal steroids Poor response in certain groups Intranasal injection not effective Immunotherapy Diet (no effect)
  • 30. Treatment Traditional polypectomy Microdebrider Endoscopic sinus surgery Recurrence Multiple small polyps common Large and antro-coanal less so
  • 31. Nasal polypectomy Nasal polyp. Stalk attached to medial maxillary wall
  • 32. Nasal Polypectomy Microdebrider entering left middle meatus
  • 33. Summary Common condition in adults Aetiology not fully understood Majority are not allergic in nature Medical treatment can be effective Even with surgery, recurrence is common